耐三代头孢大肠埃希菌血流感染的流行病学调查和危险因素分析

发布时间：2018-03-20 04:31

  本文选题：三代头孢耐药　切入点：大肠埃希菌　出处：《基因组学与应用生物学》2016年07期 　论文类型：期刊论文

【摘要】：为了探究血流感染中耐三代头孢大肠埃希菌(third-generation-cephalosporin-resistant Escherichia coli,3GCREco)的分子流行病学特点及感染危险因素,最终为临床用药和感染防控提供理论依据,我们在重庆医科大学附属第一医院2013年1月至2015年12月期间,选取了120例耐三代头孢大肠埃希菌血流感染患者作为耐药组,等比例选取120例三代头孢敏感大肠埃希菌血流感染患者为敏感组。采用VITEK2检测药敏情况、聚合酶链反应(PCR)扩增耐药基因、脉冲场凝胶电泳(PFGE)进行流行病学调查,统计相关病例资料进行危险因素分析。我们的研究结果发现耐药组120株菌株对多数头孢类抗生素表现耐药,对哌拉西林/他唑巴坦多表现敏感,对碳青霉烯类均敏感;耐药组中超广谱β类酰胺酶(ESBLs)基因占65.00%(78/120);Ⅰ类整合子基因占14.17%(17/120);氨基糖苷类基因和喹诺酮类基因检出率较低,分别占5.83%(7/120)和3.33%(4/120);PFGE结果显示菌株间不存在克隆相关性;危险因素分析结果显示尿路感染(OR=2.222;p=0.029)、感染前手术史(OR=3.063;p=0.014)、头孢类抗生素使用史(OR=2.301;p=0.036)是其独立危险因素。这些结果提示我们血流感染中耐三代头孢大肠埃希菌ESBLs基因检出率高,引起的血流感染多与头孢类抗生素使用史、尿路感染及手术史相关,为此,我们建议临床工作者合理使用抗生素,减少侵入性操作,同时加强医院感染监管工作,从而减少耐药菌的传播与流行。
[Abstract]:In order to investigate the molecular epidemiological characteristics and infection risk factors of third-generation-cephalosporin-resistant Escherichia (3GCREcoC) in blood stream infection, it can provide theoretical basis for clinical use of drugs and prevention and control of infection. During the period from January 2013 to December 2015 in the first affiliated Hospital of Chongqing Medical University, 120 patients with third generation resistant Escherichia coli infection were selected as drug resistant group. VITEK2 was used to detect drug sensitivity, polymerase chain reaction (PCR) was used to amplify the drug resistance gene, and pulsed field gel electrophoresis (PFGE) was used to investigate the epidemiology. Our results showed that 120 strains of resistant group showed resistance to most cephalosporins, sensitive to piperacillin / tazobactam, and sensitive to carbapenems. In the drug resistant group, the percentage of ESBLsof extended-spectrum 尾 -aminase (ESBLs) gene was 65.00 / 120; the proportion of class 鈪，

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